Re: Hi there back - Robin

January 20, 2004

In the best of all possible worlds, the Doc's who are on the front

line would be able to keep abreast of current research. Alas, the

time crunch. Failing that, It would seem appropriate that they would

at least attempt to look at the literature when faced with a special

needs ie. " rare " case rather than dismiss it out of hand, which has

been my experience. Neither my Rheumatologist is nor my primary

doctor are familiar with EDS, nor are they seeking knowledge in an

attempt to help me.

=====================

There was a movie out in the last year or so titled " It's All About

the s. " The " s " refer to 100 dollar bills. Time

equals money. Doctors don't have the luxury of " billable hours "

like attorneys. (And to avoid causing inadvertant offense, I will

refrain from shark jokes). And I'm not joking on this point. If an

attorney needs to look something up, they either do it (and bill the

client for the time), or they have one of their legal assistants do

it, (and bill the client for the time). The attorney is going to

earn his fee whether he is researching the case or arguing before

the bar. (You can pay $500 an hour to a seasoned attorney with lots

of experience in your situation or you can pay $100 an hour for a

newbie to spend five hours researching your case).

Not so for the doctor.

A medical practice involves not only an extremely high cost to get

there (education), but also an enormous overhead which includes

crushing malpractice premiums. In virtually most cases (there are

obviously exceptions) a doctor starts his career with a staggering

debt. He then has to set up his practice by incurring even more

debt to buy everything he needs. And, of course, he has staff to

pay. At minimum, he is going to have a nurse and receptionist. He

needs a minimum revenue stream just to break even. Every hour he

spends on medical research is an hour for which he is not being

paid.

There are two types of doctor that can afford to do this. One is

the new kid on the block who is just starting his practice and who

is not fully booked with patients. He might have chunks of time

where he is not doing something else and can therefore do some

review and research. The other is the well established doctor with

a successful practice who has already paid off his school loans and

his start-up equipment costs. One who is operating profitably and

can afford to invest in some initial, non-billable, time researching

something that either interests him or can benefit a patient.

Most of them, however, simply can't afford to. Please note, I did

not say that the motivation is greed. There is obviously some of

that out there. There is some of that in every profession. The

prime consideration, however, is just basic economics. And yes, I

am aware that the medical profession requires continuing education.

Most of them, however, are going to devote that continuing education

time and expense to areas where they are going to get a higher long-

term return on their investment. They are going to spend it on

learning things to benefit patients with conditions that they see

every week rather than once every year or two.

And this is one of the real values of things like the CEDA list. It

is a tremendous source of information, not only to educate people

WITH EDS, but for people with EDS to help educate their own doctors.

The good ones are going to take the literature and info you provide

them, read it, and thank you for it. Then there are others who

either " can't be bothered " or who actually resent that you, as the

patient, even presume to know more than they do about their field.

The problem is tracking down those good ones.

January 20, 2004

> Doctors don't have the luxury of " billable hours " like attorneys.

My friend has two children in college. Her daughter is in medical school

and her son is working on his degree in accounting. Several months ago,

they were speaking of their respective careers in terms of their future

earning potential. The daughter quoted one of her professors as follows:

" In medicine, we don't have billable hours. We bill by procedure. With

billable hours, you are constrained by the amount of hours in a day, and

therefore your income is limited to the number of hours in which you work.

In medicine, we bill by procedure and there are no limits on the number of

procedures you may perform. "

This is what we are teaching our doctors in the USA.

-Barb

January 20, 2004